RESUMEN

BACKGROUND: Cryptosporidium is an intracellular protozoan organism which causes diarrhea, both in immunocompetent and immunocompromised hosts. Renal transplant recipients are prone to develop a variety of infections including protozoal infections. OBJECTIVES: The aim of this study was to determine the prevalence of cryptosporidiosis in our renal transplant recipients presenting with acute diarrhea. PATIENTS AND METHODS: During six months of the study, 644 renal transplant recipients presented with acute diarrhea. Single stool sample was obtained for detailed analysis including gross and microscopic examination for red blood cells, pus cells, ova, cysts, and protozoa. The modified Ziehl-Neelsen (ZN) staining was done to identify the oocysts of cryptosporidia. RESULTS: Out of 644 renal transplant patients, oocysts of cryptosporidia were identified in 343 patients (53%). Detailed stool analysis of these patients showed the presence of numerous pus cells in 27 (7.9%) patients, co-infection with giardia intestinalis cysts in 15 (4.3%), and entamoeba histolytica cysts in 10 (2.9%). In all, out of 343 patients, 43 (12.5%) had dual infection with bacteria and protozoa in addition to cryptosporidiosis. CONCLUSIONS: Cryptosporidium is an important pathogen causing acute diarrhea in renal transplant recipients in our set up. Stool examination is usually negative for pus cells. It is recommended that in all transplant recipients presenting with acute diarrhea modified ZN staining should be done to rule out cryptosporidiosis in highly endemic areas like Pakistan.

RESUMEN

OBJECTIVE: To document the prevalence, clinical presentation and treatment outcome of cryptosporidiosis in immunocompetent adult patients presenting with acute diarrhoea. METHODS: This prospective cohort study was conducted at the Sindh Institute of Urology and Transplantation Karachi from February 1, till September 30, 2012. All immunocompetent adult patients who presented with acute diarrhoea to the gastroenterology clinic at SIUT were included. Data collection sheet was filled and stool studies sent. Modified acid fast stain of stool was performed for cryptosporidium. SPSS 20 was used for statistical analysis. RESULTS: There were 105 patients with acute diarrhoea. Fifty three (50.4%) were males. The mean age was 34 +/- 8.4 years. Of 105, 58 (55%) patients had cryptosporidium isolated in stool studies. Patients with cryptosporidiosis had statistically significant greater stool frequency per day (p < 0.001, OR = 12.7; CI [4.4-37.11), abdominal pain (p < 0.001, OR = 19.8 [6.1-64.11), vomiting (p < 0.001, OR = 7.3 [2.7-19.9]), low grade fever (p < 0.001, OR = 8.5 [3.5-20.8]), fatigue (p < 0.001, OR = 8.4 [3.2-21.6]) and dehydration and a shorter duration of illness with more watery diarrhoea. All 58 patients reported resolution of diarrhoea after 7 days of treatment with nitazoxanide. However, 40 (70.1%) patients reported recurrence of diarrhoea within 6 weeks of treatment. CONCLUSION: Our study demonstrates a high prevalence of cryptosporidiosis in immunocompetent adult patients. Nitazoxanide is the recommended antimicrobial drug for cryptosporidiosis.

Asunto(s)

Antiparasitarios/uso terapéutico , Criptosporidiosis/diagnóstico , Criptosporidiosis/tratamiento farmacológico , Diarrea/parasitología , Tiazoles/uso terapéutico , Enfermedad Aguda , Adulto , Animales , Criptosporidiosis/epidemiología , Diarrea/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nitrocompuestos , Pakistán/epidemiología , Prevalencia , Estudios Prospectivos , Resultado del Tratamiento

RESUMEN

Juvenile hyaline fibromatosis is a rare inherited autosomal recessive disorder which is caused by mutation of CMG2 gene on chromosome 4q21. Mutation of this gene protein can disrupt the formation of basement membranes. Hyalinization of various body tissues like skin, joints, and bones leads to development of skin papules, gingival hyperplasia, osteolytic lesions in bones, and joint contractures. We had a case of a 3 years old female child with Juvenile Hyaline Fibromatosis who presented with rectal bleeding. She had a bleeding mucocutaneous lesion in anal canal along with papullonodular lesions on the face, gingival hypertrophy and flexion contractures of small joints of hands and feet. Excision of the anal lesion revealed histopathological features of Juvenile Hyaline Fibromatosis.

Asunto(s)

Hemorragia Gastrointestinal/etiología , Síndrome de Fibromatosis Hialina/complicaciones , Síndrome de Fibromatosis Hialina/diagnóstico , Preescolar , Diagnóstico Diferencial , Femenino , Humanos

RESUMEN

Amyloidosis is a disorder of protein metabolism characterized by extracellular deposition of abnormal protein fibrils. It may either be localized to any organ or systematically distributed throughout the body. The biochemical nature of proteins varies but the physical and tinctorial properties are shared by all the amyloidogenic proteins. In the West, it is mainly composed of amyloid light (AL) type immunoglobulin (Ig) light chains. Amyloidosis of the genitourinary tract is rare except for the kidney and isolated primary amyloidosis of the urinary bladder is even rarer. It mainly presents as intermittent painless gross hematuria. It mimics transitional cell carcinoma on imaging and endoscopic examination. We herein present a case of fifty six-years-old male with history of painless hematuria for three months. Cystoscopy revealed a 1 cm hyperemic area on the posterior wall of urinary bladder. The biopsy showed features of amyloidosis and amyloid A (AA) immunostaining was negative. Extensive workup was done to exclude other sites of involvement and a final diagnosis of primary localized amyloidosis of the urinary bladder was made. The patient is on regular follow-up.